SWAZILAND COUNTRY PRESENTATION Presented by: Lindiwe Tsabedze MOH NCD Focal Point 8th WHO-IUMSP International Seminar on the Public Health Aspects of NCDs 2-7 June 2014 Laussane; Geneva

BACKGROUND

Background contd….. Official Name: Kingdom of Swaziland Capital: Mbabane Location: In Southern Africa Landlocked by the Republic of South Africa and Mozambique Assets: asbestos, coal, clay, cassiterite, hydropower, forests, small gold and diamond deposits, quarry stone, and talc. SWAZILAND TOP NCD CAUSES OF DEATH HIV&AIDS Stroke Coronary Heart Disease Diabetes Mellitus T.B Violence Road Traffic Accidents Lung Disease SWAZILAND CANCER RANK BY TYPE Cervical Cancer Liver Cancer Oesophagus Cancer Breast Cancer Other Neoplasms Lung Cancers Colon- Rectal Cancer Stomach Cancer

ACHIEVEMENTS Advocated for budget to strengthen NCDs at community level. Initiated a new cadre of lay trainers – out of school youth. NCD Policy and Strategy finalized. Tobacco legislation passed; now policy and interventions being drawn. In process of conducting STEPS II. Population Based Cancer Registry – in progress. Protocols and guidelines on DM; CVDs; Asthma; and Diets some completed some in progress. Have initiated walk in screening units in partnership with city councils for early detection and early initiation of treatment. Working on child targeted NCD interventions. Preparing to initiate amongst girls HPV vaccine as a prophylaxis against breast cancer. Conducting 5 in patient based retrospective study to study trends in NCD mortality and morbidity. Radiotherapy services a work in progress.

STRUCTURE / RESOURCES NCD Unit available and functional. Reasonable budget from Gout approx $1500 annually since 2014. NCD services available in all Hospitals; Health facilities and in about 200% in PHC NCD NGOs and support groups: Diabetes Swaziland; Cancer Survivors; Cervical & Breast Cancer Network; NCD Alliance; FBOs. More Partners coming on board and integration of T.B & HIV into NCDs. One stop NCD Clinic upcoming Filter Clinics targeting NCD screening & limited case management. Offices well capacitated with working tools – computers; printers etc

CHALLENGES NCDs prioritized in documents but not in reality. Lack of Human Resources. No transport. Supportive supervision minimal therefore NCD activities moving too slowly. Need partners to assist in many areas such as : Transport acquisition; Health System strenghening; Redefining the disease profile at M&E. NCDs severly under reported. Government needs to be advicated to respond more speedily to the NCD epidemic. Reasources for capital NCD projects such as procurment of correct diagnostic tools for the referral hospital. More emphasis needed on preventetive strategies.

LESSONS LEARNT Patience. How to improve when conducting STEPS 11 NCDs needs proper structuring and key focal points. Some interventions have to be accelerated such as early detection. The Government needs to find means to be self sufficient and rely less on Donor funding for sustanainability. NCDs are not a Ministry of Health problem but need a whole of Govt concerted approach. Drugs and diagnostics need to be purchased straight from the source to ensure better use of the budget. Capacity buliding is needed across all government structures and across all cadres health and otherwise. Awareness on NCDs needs to be accelerated as prevention is better than cure.

NEXT STEPS Increased advocacy amongst the Ministry of Health and Cabinet on NCDs. Capacitate NCD NGOs to improve and accelerate advocacy strategies. Increased collaboration and sharing within partners in and out of country. Conduct more research to obtain good data which will inform policy and guidance on NCDs. Swaziland is very small; one language + English and good infrastructure therefore the NCD disease profile can have a quicker turn around. Take lessons from HIV / AIDS and T.B programming although they have more than triple the resources.

Thank You.